CCH S DNG MU V CC CH PHM T MU

ThS. BS. Nguyn Th Thanh

MC TIU HC TP
1. S dng ng cc ch phm ca mu
2. Chn on v x tr c cc tai bin truyn mu
3. Thc hin c qui trnh truyn mu an ton
1. MU V CC CH PHM T MU
2. Mu ton phn
Ngnh huyt hc hin i ngh ch truyn cho BN thnh phn ca mu m h cn,
ngha l nn dng cc ch phm t mu. Do , mu ton phn t khi dng, ngoi tr lc thay
mu tr s sinh. Mt n v mu ton phn cha 435-500 ml mu v cht chng ng l
CPDA-1 (citrate phosphate dextrose adenine). Mu ton phn khng cn l ton phn thi
im truyn v 24 gi sau khi ly mu, tiu cu v mt s yu t ng mu gim. Sau 72 gi,
hu nh khng cn tiu cu sng v mt hot tnh ca yu t VIII trong mu ton phn.
Mu ton phn c u im l cng lc cung cp th tch v ci thin kh nng chuyn ch
oxygen. Tuy nhin, iu ny cng c th thc hin bng cch truyn hng cu lng v dch
tinh th. Bt li ca mu ton phn l cha rt t yu t ng mu, c lng kali cao, H +,
ammonia, BN nhn mt lng ln khng nguyn, v b qu ti th tch trc khi t mc
dung tch hng cu mong mun.
3. Mu ti
Mu ti l mu va c ly < 6 gi, c Hct 35%, c cc yu t ng mu v tiu cu.
Mt n v mu ti c hiu qu cm mu tt nh 10 n v tiu cu. Tuy nhin, khng phi
lc no cng c mu ti dng.
CC CH PHM T MU:
Mt n v mu va c ly, mu s c tch ra tng thnh phn: hng cu, tiu cu,
plasma, ta ng. K thut ny cho php s dng ti a cc thnh phn ca mu v cch lu
tr thch hp.
1. Hng cu lng
Hng cu lng c ly ra t mu ton phn bng cch rt bt 80-90% plasma. Dung
dch bo dng cha dextrose, adenine v mannitol cho php d tr c 42 ngy. Hng cu
lng c gi 4o C. Mi n v hng cu lng c th tch 250 ml, c Hct 70%, s lm tng
hemoglobine ln 1 g/dL hay 3% Hct. Sau khi truyn, c 70% hng cu sng sau 24 gi v
nhng hng cu ny c i sng sinh hc bnh thng. Hng cu lng khng cha yu t
ng mu, nn sau khi truyn nhanh khong 5 n v hng cu lng th phi truyn plasma
ti ng lnh. u im ca hng cu lng so vi mu ton phn l gim nguy c qu ti th
tch, gim lng citrate, ammonia v cc acid hu c, gim nguy c bnh min dch (allo
immunization) nh cha t khng nguyn. Hng cu lng lm tng nhanh kh nng chuyn
ch oxygen BN b chy mu cp hay mn.
Ch nh truyn hng cu lng:
- Chy mu cp trong chn thng, xut huyt tiu ha hay v phnh ng mch ch bng.
BN khe mnh mt > 1500 ml mu (25-30% th tch mu ca ngi 70 kg) c th c b
hon ton bng dch tinh th. Nu mt hn lng ny, cn truyn hng cu lng tng kh
nng chuyn ch oxygen v dch tinh th b th tch tun hon.
- Mt mu ngoi khoa: BN khe mnh i m thng khng cn truyn mu cho n khi Hb
< 7 g/dL hay cuc m mt mu nhiu. Mt mu trong lc m 1500-2000 ml thng c th ch
cn b bng dch tinh th nu trc m BN c huyt bnh thng. Phn ln BN ch cn
truyn hng cu lng v dch tinh th nu mt mu trn 2000 ml.

- Thiu mu mn tnh cn truyn hng cu lng nu Hb < 7 g/dL hay nu BN c triu

chng hay bnh l tim phi.
Ngoi hng cu lng, c cc ch phm khc nh hng cu ngho bch cu, hng cu
ng lnh, hng cu ra dnh cho mt s Bn c bit.
2. Hng cu ngho bch cu c ly bt 70-85 % bch cu bng cch ly tm, lc hay
chiu tia cc tm. Ch phm ny dnh cho BN ghp c quan hay chun b ghp c quan
nga phn ng min dch chng bch cu v nhng bnh nhn c tin cn st sau truyn
mu.
3. Hng cu ng lnh c chun b bng cch cho thm cht bo v hng cu khi
ng lnh (cryoprotective agent) v d tr hng cu trong vi nm nhit ng lnh. Qu
trnh ng lnh s ph hy cc thnh phn khc ca mu ngoi tr cc t bo lympho min
dch. Trc khi truyn, hng cu c r ng, ra ly i 99,9 % plasma v cc mnh vn
t bo. Qui trnh ny rt t tin nhng c th cung cp mu cho ngi c nhm mu him,
hng cu c kh nng chuyn ha cao v gim nguy c tip xc khng nguyn cho BN ghp
c quan.
4. Hng cu ra c lm t mu ton phn hay hng cu lng. Ra hng cu bng
nc mui sinh l, nh ly ht plasma, mt s bch cu v tiu cu. Hng cu ra phi
c truyn trong 24 gi v nguy c nhim vi khun trong qu trnh ra. Hng cu ra dng
cho BN b phn ng mn cm vi plasma (BN thiu IgA), truyn mu cho tr s sinh hoc
BN b tiu mu do tn huyt ban m trnh giai on tn huyt.
5. Tiu cu
Tiu cu c ly t mu ton phn hay bng cch lc plasma. Tiu cu c th gi c
trn 5 ngy 20-24o C v phi lc lin tc, nhng cht lng tiu cu s tt nu c dng
ngay. Khi truyn 6 n v tiu cu m c hay 1 n v tiu cu bng cch lc plasma s c
th tch 250-300 ml cha 4 x 1011 v s lm tng tiu cu t 50.000-60.000/ml. m tiu cu
sau truyn tiu cu 1-24 gi. Tiu cu c truyn c th sng 3-5 ngy, ngoi tr b hi
chng tiu th tiu cu hay b tr. Nu b gim tiu cu do tng ph hy tiu cu (do khng
th chng tiu cu) hay do tiu cu b ri lon chc nng, truyn tiu cu s t hiu qu. Nu
c th c, nn truyn tiu cu ng nhm mu ABO trnh truyn th ng plasma
khng tng hp ABO. Hin tng ny rt quan trng khi truyn mu cho BN cn nng < 40
kg hay BN truyn nhiu tiu cu. Mt s hng cu cn st li trong bch tiu cu nn ph n
Rh m trong tui sinh phi c truyn tiu cu Rh m. Tiu cu phi c truyn qua
mng lc 170 micron. Hai mng lc 40 micron Pall SQ40S v Pall LRF10 c chuyn dng
ly ht bch cu khi truyn tiu cu. Dng cc mng lc ny c li l lm gim phn ng
st hin din ca hng cu v bch cu trong bch tiu cu.
Ch nh truyn tiu cu:
- Gim tiu cu < 20.000/ mm3 do suy ty.
- Gim tiu cu do tiu th. Tun hon ngoi c th, ng mu ni mch lan ta, phu thut
chy mu nhiu hn mt th tch mu v tiu cu < 50.000.
- Tiu cu trong khong 10.000-50.000/ mm3 c nguy c chy mu khi b chn thng hay
lm th thut xm ln, chy mu t nhin hay sau th thut, bnh l gan thn gy ri lon
chc nng tiu cu c th b chy mu t nhin mc tiu cu ny.
Tiu cu c bit c dnh cho cc BN c bit. BN khng p ng sau truyn tiu cu
phi c truyn tiu cu ng nhm HLA. BN suy gim min dch truyn tiu cu c
chiu tia nga bnh min dch xy ra do nhim bch cu.
6. Huyt tng ti ng lnh
Huyt tng ti ng lnh l huyt tng c tch ra t mu ton phn v c ng
lnh trong vng 6 gi sau khi ly v d tr -18 o C. Mt n v huyt tng ti ng lnh
cha 200 ml v theo nh ngha cha 1 n v yu t ng mu/ml v 1-2 mg fibrinogen/ ml.
Truyn huyt tng ti ng lnh phi theo nguyn tc nhm mu tng ng ABO. Liu bt

u 10-15 ml/kg hoc 2-4 n v huyt tng ti ng lnh lm tng yu t ng mu ln

30%. ha gii nhanh tc dng ca thuc khng vitamine K, cn 5-8 ml / kg huyt tng
ti ng lnh. Huyt tng ti ng lnh c truyn trong vng 2 gi sau khi r ng v
truyn qua mng lc 170 micron. Sau khi truyn, nh gi bnh nhn v tnh trng chy mu
v chc nng ng mu. Huyt tng ti ng lnh khng c ch nh tng th tch
tun hon.
Ch nh truyn huyt tng ti ng lnh:
- Chy mu cp km gim ton b yu t ng mu.
- Bnh l ng mu do tiu th km gim nng cc yu t ng mu.
- BN c gim mt yu t ng mu bm sinh khi khng c ch phm chuyn bit truyn
(BN thiu fibrinogen n thun, yu t VIII hay yu t XIII thng c iu tr bng ta
ng).
- BN c ban xut huyt do gim tiu cu (thrombotic thromcytopenic purpura) trong khi
phi thay huyt tng.
- BN b truyn mu khi lng ln v c triu chng ca ri lon v ang chy mu.
- BN thiu antithrombine III (gy khng heparine) khi khng c antithrombine III m c
truyn.
7. Ta ng (cryoprecipitate)
Ta ng l thnh phn protein kt ta do lnh ly t huyt tng ti 1-6 o C, d tr
ng lnh trong vng 1 nm. Mt n v ta ng c th tch l 15 ml v cha 40 n v yu
t VIII, yu t XIII, lng ln yu t von Willebrand,150 mg fibrinogen v fibronectine.
Liu dng thng dng l 2-4 n v /10 kg hay 10-20 ti mi ln. Khi truyn khi lng
ln, nn dng ta ng theo nhm mu ABO, trong vng 6 gi sau khi r ng v qua mng
lc 170 micron.
Ch nh truyn ta ng:
- BN c gim fibrinogen. BN b thiu fibrinogen bm sinh hoc ng mu ni mch lan
ta, c ch nh truyn ta ng khi fibrinogen < 100 mg/dL. Cho bnh nhn cn phu thut
ngay sm sau khi iu tr thuc tiu si huyt, c gim nng fibrinigen.
- Bnh Von Willebrand v ang chy mu, truyn ta ng khi khng c desmopressine
(DDVAP) hoc DDVAP khng hiu qu v khng c yu t VIII m c c cha yu t Von
Willebrand.
- Bn b hemophilia A khi khng c yu t VIII m c dit virus.
- Dng trong phu thut nh keo dn fibrine.
- Thay th fibronectine tng hiu qu lnh so BN b chn thng, phng nng, nhim
trng.
8. Albumine
Albumine chim 50% protein lu hnh v 75% p lc keo ca huyt tng. Sn phm
albumine c nng 5-25% trong nc mui sinh l. Ch phm ny c dit virus bng
nhit 600 C trong 10 gi v khng c kh nng truyn bnh do virus.
Ch nh truyn albumine c nhiu bn ci nhng c cc ch nh chnh sau:
- Duy tr p lc keo. Nhiu nghin cu lm sng cho thy dung dch keo khng c li hn
dung dch tinh th trong iu tr sc mt mu cp. Sau khi truyn, albumine s nhanh chng
phn phi vo khoang ngoi mch, v t tin.
- Lc huyt tng th tch ln Bn b ascite nng (large volume paracentesis).
- Bn b phng nng. Nhiu trung tm b ch nh ny.
9. Immunoglobuline
Immunoglobine min dch IV (IV Ig) ngy cng c s dng nhiu trong ni khoa.
C vi bin chng ly truyn virus vim gan siu vi C do dng IV Ig c bo co.
Ch nh dng IV Ig:

- Gim min dch nguyn pht hay th pht nh gim min dch bm sinh, bch cu
lympho mn, ghp ty, tr em nhim HIV v nga nhim trng tr s sinh thiu thng v
nhim trng Bn nm Hi Sc.
- Bn b ri lon min dch v phn ng vim nh ban xut huyt gim tiu cu hay hi
chng Kawasaki.
Bin chng c th xy ra khi truyn immunoglobuline l:
- Phn ng mn cm c th xy ra Bn thiu IgA. Bn cn truyn sn phm loi b IgA.
- C phn ng huyt thanh dng tnh tm thi do truyn th ng khng th chng vim
gan siu vi C v cytomegalovirus.
10. Antithrombine III (AT III)
AT III l protein trong plasma c tnh c ch cc yu t ng mu nh thrombine hot
ha (yu t IIa) v yu t IXa, Xa, XIa, XIIa. Thiu AT III c th bm sinh hay mc phi. Ch
phm ny c dit virus HIV-1 bng nhit 60O C trong 10 gi. AT III c dng rng ri
cho Bn b thiu AT III bm sinh km tc mch cp hay nga thuyn tc mch cho Bn. Hin
ang dng th nghim AT III nga thuyn tc mch mu sau m, cp cu sn khoa, sc
hay ng mu ni mch lan ta.
11. Cc yu t ng mu khc.
Bnh thiu yu t ng mu bm sinh thng sinh thng gp nht hemophilia A,
hemophilia B, Von Willebrand. Ch nh truyn cc yu t ng mu trong cc trng hp
khc khi c chy mu cp.
II. BIN CHNG TRUYN MU
Cp tnh
1. Phn ng tn huyt cp
- Tn huyt cp sau truyn mu xy ra do truyn nhm nhm mu ABO. Tn huyt xy ra
do hng cu khng tng hp b hy ngay tc khc bi khng th.
Triu chng: Bn st, lnh run, au lng, kh th, au ni truyn mu. Nng hn, Bn b
tt huyt p, chy mu, suy h hp, hoi t ng thn cp. Trng hp nng xy ra khi Bn
ang gy m hay mt tri gic, khng th ni cho BS bit cc triu chng kh chu.
X tr: ngng truyn mu. Gi mu v chai mu i xc nh nhm mu. Tng lng nc
tiu (t nht 100 ml/gi) bng cch truyn nc mui sinh l v furosemide. Nng tun
hon, nu cn dng thuc co mch. Xt nghim nh gi tn huyt nh tm Hemoglobine t
do trong mu, trong nc tiu, haptoglobine, bilirubine. Phn ng Coomb trc tip v gin
tip phi lm trc v sau khi truyn mu, cng thc mu, creatinine, ng mu (PT, aPTT).
- Mt phn ng nh v t gp l tn huyt xy ra ngoi mch mu (l lch), thng xy ra
do khng tng hp yu t Rhesus. BN ny thng khng c triu chng v t khi c tng Hb
t do trong mu v Hb niu. Xt nghim thy phn ng Coomb (-) trc m nay chuyn sang
(+), tng bilirubine gin tip v khng p ng vi truyn mu (Hb v Hct khng tng nh d
kin). Khng cn iu tr.
2. St sau truyn mu
Trong khi ang truyn mu hay vi gi sau khi truyn BN st v lnh run. Nguyn nhn
l do khng nguyn - khng th trong huyt tng, tiu cu hay bch cu c truyn cho BN
km vi hng cu. Trng hp ny thng gp BN truyn mu nhiu ln hay sn ph c
nhiu con. Phn ng st khng tn huyt thng nh, nhng cng c th nguy him tnh
mng nu BN c tnh trng tim phi khng tt hay ang bnh nng.
X tr: ngng truyn mu.
Trn lm sng, khng th phn bit ngay t u phn ng st khng tn huyt v phn
ng tn huyt. Loi tr tn huyt bng cch lm li phn ng cho v Coomb. Loi tr st do

nhim trng. BN c tin cn st sau truyn mu c th dng acetaminophen, aspirine v

meperidine trc khi truyn nga lnh rung hay truyn mu loi bch cu.
3. D ng
Do d ng vi protein trong huyt tng thng gp BN thiu IgA. Triu chng in
hnh: da, m ay, nga, co tht ph qun, ri lon vn mch v i khi sc phn v. D
ng thng nh. nng ca phn ng khng ty thuc lng mu truyn, c th tip tc
truyn mu. Khi phn ng d ng xy ra, tm ngng truyn mu, nh gi tnh trng BN v
cho thuc khng histamine nh diphenhydramine. Nu BN ci thin vi iu tr, tip tc
truyn mu. Mt s BS cho thuc trc khi truyn mu cho BN c tin cn d ng khi truyn
mu.
A. Bin chng mun
1. Nhim trng
T khi HIV-1 c nh danh vo gia thp nin 80, c nhiu k thut tm sot nhim
HIV bo m an ton truyn mu. Phn ln mu truyn c ly t ngi hin mu t
nguyn an ton hn l mu ly t ngi bn mu. C 2 mc tm sot ngi cho mu:
(1) ngi cho mu tr li bng cu hi loi tr nhng i tng c nguy c cao ly nhim
HIV; (2) Xt nghim mu loi tr HIV, vim gan siu vi B, C, giang mai, st rt. Mt s
ch phm t mu c x l cht dit virus. Nguy c nhim trng khi truyn mu thay i
ty theo t l bnh nhim trng ca ly mu. i khi mu b nhim trng trong lc chun b
hay t ngi cho ang b bnh nhim trng.
2. Phn ng tn huyt mun
Xy ra 7-10 ngy sau truyn mu do phn ng khng nguyn-khng th sau truyn mu.
Xt nghim cho thy hng cu gim dn v test Coomb m tnh trc khi truyn mu tr nn
dng tnh. BN thng khng c triu chng g.
3. D th tch tun hon
Truyn hng cu lng hay huyt tng lm tng nhanh th tch tun hon. Ngi c chc
nng tim mch gii hn, c bit l tr em v ngi gi c th khng chu c s gia tng
th tch tun hon ny. Khi , BN thy au u, th nhanh, khm c triu chng suy tim
huyt.
iu tr: Gim tc truyn, cho li tiu. Tc truyn mu ngiln l 2-4
ml/kg/gi. Nu BN c nguy c d nc th truyn chm 1 ml/kg/gi.
4. H thn nhit
H thn nhit xy ra khi BN c truyn mt s lng ln mu lnh. Thng xy ra khi
truyn nhanh t 3 n v mu tr ln. Hng cu lng d tr 4 0 C, tiu cu 20-240 C, huyt
tng ti ng lnh -180 C. My si m mu c th dng nhng khng c > 40 0 C v
gy tn huyt. Cch n gin nht lm m mu l truyn mu cng vi nc mui sinh l
m (39-430 C) va lm m va pha long mu.
5. Ph phi khng do tim
Ph phi khng do tim c cho l do bt tng hp ca khng th bch cu c truyn
vo. Phn ng xy ra sau 4 gi truyn mu. Lm sng, BN c suy h hp, st, lnh run, tim
nhanh. X quang phi c hnh nh thm nhim lan ta nhng bng tim khng to. Khng c
triu chng ca d nc hay suy tim huyt. Trong a s trng hp, thm nhim phi s
ht sau vi ngy v ch cn iu tr nng . Tuy nhin, phn ng ny s rt nng nu BN
ang bnh nng.
6. Ri lon in gii
Mu d tr c cha citrate lm cht chng ng gy gim calci mu. Nhng gim calci
mu nng t khi xy ra do qu liu citrate v BN c chc nng gan bnh thng s chuyn ha
citrate thnh bicarbonate. Ngay c khi truyn mu nhiu, cng t khi phi b calci.
Gim kali mu c th xy ra nu truyn mu nhiu. Khi citrate c chuyn ha thnh
bicarbonate s lm kim mu v gy di chuyn kali vo t bo.

Tng kali mu t l vn sau truyn mu mc d mu d tr c lng kali cao, nhng s

l vn cho BN suy thn hay s sinh.
1.

TRUYN MU CP CU
Trong tnh hung cp cu, mu O Rh m hay mu ng nhm nhng cha lm phn ng
cho c th cu mng BN nhng c nguy c b cc phn ng truyn mu nng. K thut ny
ch c lm gii hn trong giai on cp cu ca iu tr sc nng do mt mu t v khng
p ng vi truyn dch tinh th. nh nhm mu ABO lm trong 10-15 pht sau khi nhn
mu mu s gip trnh c phn ln cc bin chng do truyn mu. Phn ng cho lm
trong vng 30-60 pht. Nu khng c mu cng nhm, dng mu O Rh m truyn. Khi c
mu cng nhm th truyn ngay hn ch lng plasma O c truyn vo (c cha khng
th anti-A v anti-B). Nn dng mu Rh m nu khng lm phn ng cho ton phn c.
Hng cu lng l ch phm mu duy nht c dng truyn mu khn. Plasma cha rt
nhiu khng th v khng c vai tr trong chy mu t giai on u. Ngay khi c hng cu
lng ng nhm lm phn ng cho, cn truyn ngay hng cu lng ny. Lm phn ng
cho v sau s cng kh khn nu truyn mt lng ln mu khng lm phn ng cho.
III. TRUYN MU KHI LNG LN
Theo nh ngha truyn mu khi lng ln l truyn mt lng mu tng ng vi
th tch mu ca BN trong vng 24 gi. Bin chng thng gp l chy mu, ng c citrate
v h thn nhit. Chy mu l bin chng thng gp nht do thiu tiu cu v yu t ng
mu. Gim tiu cu khng phi lun lun xy ra v sau khi thay hon ton mt th tch mu,
a s BN vn c 35-40% tiu cu # 100.000/mm 3. Chy mu thng xy ra khi gim tiu cu
kt hp vi ri lon chc nng tiu cu do bnh gan thn hay ng mu ni mch lan ta v
thiu yu t ng mu. Thiu yu t ng mu xy ra khi truyn mu khi lng ln v mu
d tr cha t yu t ng mu, c bit l yu t V v VIII. Ri lon ng mu cng nng
hn khi c h thn nhit, sc, nhim trng, bnh gan hay ng mu ni mch lan ta.
Trong thc hnh lm sng, vic truyn thng qui tiu cu v plasma ti ng lnh cho
BN truyn mu khi lng ln l khng an ton, tn km v nguy him. Truyn tiu cu khi
c gim tiu cu do ng hay chy mu ko di. Truyn plasma ti ng lnh khi c bng
chng ri lon ng mu v chy mu. Trong k thut truyn mu hin i, t khi b ng c
citrate tr khi truyn mu ton phn. BN nhn > 5 n v mu ton phn, tr s sinh hay BN
bnh gan c nguy c gim calci mu. o ion calci trong mu. on QT khng phi l ch s
chnh xc ca gim calci BN truyn mu khi lng ln. Nu cn b calcium, cho
gluconate calcium 5-10 ml.
H thn nhit l nguy c tim tng khi BN nhn trn > 3 n v mu truyn nhanh. Khi
truyn lng mu ln, cn si m mu hoc truyn mu km nc mui sinh l m nga
h thn nhit do truyn mu.
1. K THUT TRUYN MU
1. nh nhm mu v phn ng cho
Mu ngi cho v ngi nhn phi c nh nhm theo khng nguyn trn b mt hng
cu ABO v Rhesus, cng nh tm cc khng th bt thng. Phn ng cho c lm bng
cch trn plasma ca ngi nhn vi hng cu ngi cho xem c hin tng tn huyt xy
ra do hin din ca khng th hay khng. Trn b mt hng cu c th c khng nguyn A,
khng nguyn B hay AB hay khng c khng nguyn. Nu trn hng cu khng c khng
nguyn A hay B th plasma c khng th chng khng nguyn . Nh vy, ngi c nhm
mu B s c khng th anti-A trong plasma. Ngi c nhm mu O (hng cu khng c
khng nguyn A v B) s c khng th anti-A v anti-B. Ngi c nhm mu AB, plasma s
khng c khng th anti-A hay anti-B, nn c th nhn mu ca cc nhm mu khc. Nhm

mu O khng c khng nguyn A hay khng nguyn B nn c th cho mu cho cc nhm

mu khc.
Khng nguyn b mt Rhesus c th c (Rhesus dng) hay khng (Rhesus m). Ngi
Rhesus m s to khng th chng Rh khi tip xc vi mu c Rh dng. Hin tng ny
khng quan trng khi truyn mu ln u, nhng ln truyn mu sau s b tn huyt do khng
th lu hnh. y l vn c bit ca ngi mang thai. Khng th anti-Rh l IgG v qua
nhau t do. Nu m Rh(-) c khng th chng Rh, khng th ny truyn qua thai nhi. Nu thai
nhi c Rh(+), tn huyt thai nhi s xy ra. RHO-immune globuline, khng th chn Rh,
nga BN Rh m to khng th anti-Rh. RHO-immune globuline phi c truyn cho BN
nhn mu Rh dng hay cho m Rh m khi sinh con Rh dng (v c tip xc mu m - mu
con khi sanh). Liu: 300 g TB cho mi 15 ml mu Rh dng c truyn.
2. An ton truyn mu
Truyn mu phi xc nh r tn BN, nhm mu ca BN v nhm mu ca bch mu
truyn. Kim tra ln cui cng ti ging bnh trc khi truyn: kim tra ng thi mu BN
v mu s truyn vi huyt thanh anti-A, anti-B, v anti-AB trn mt tm knh. Cc phn ng
ca mu truyn v mu BN phi ging ht nhau (c ngng kt hay khng ngng kt). thy
r hin tng ngng kt, ch nn dng mt git mu nh so vi git huyt thanh.
Dng kim ln 16-14 G nga tn huyt v cho php truyn nhanh khi cn. Nc mui
sinh l l dch tinh th duy nht tng hp vi hng cu lng. Nu cn truyn nhiu n v
hng cu lng hay cn truyn nhanh, nn truyn km vi dung dch mui sinh l m 39 0 C
hay dng my si m mu bng in. Mu s b tn huyt nu si m ln 40 0 C. Ngoi tr
trng hp khn cp, mu phi c truyn chm trong 30 pht u tin, l giai on m
phn ln cc phn ng s xy ra. BN khng c bnh l tim mch c th truyn 1-2 n v
hng cu lng trong 1-2 gi. Nhng ngi c nguy c d nc phi truyn chm 1 n v
trong 3-4 gi. B lc 170 micron c dng lc mnh vn tiu cu, fibrine, bch cu.
Truyn mu nhanh bng cch dng my bm mu bng p lc trn 300 mm Hg.
TI LIU THAM KHO
2. Marie B, Spielvogel C. Produits sanguins. Trong: Le livre de linterne anesthsiologie.
Mdecine-Sciences. Flammarion 1998, chapitre 11: 182-201.
3. Bojar RM. Treatment of mediastinal treatment. Trong: manual of perioperative care in
cardiac and thoracic surgery. Blackwell science, 1999: 164-168.
4. Rae MA. Transfusion therapy. Trong: Clinical Anesthesia procedure of the Massachusetts
General Hospital. Lippincott-Raven, 2002: 543-547.